The Centers for Medicare & Medicaid Services is soliciting ideas from stakeholders about new approaches that might be employed in the development of state relief and empowerment waivers, also known as section 1332 waivers.

Last year CMS loosened section 1332 waiver requirements and offered states four concepts for how to take advantage of both the waivers and the less stringent requirements.  Section 1332 waivers permit states to seek exemption from selected requirements of the Affordable Care Act to pursue new approaches to enhancing access to quality, affordable health insurance.  Through a new request for information, CMS now seeks

…to build a library of options, through more waiver concepts, so that states have additional illustrative ways to take advantage of this new flexibility.

In its RFI, the agency suggests the following possibilities:

• Waiver concepts that states could potentially use alone or in combination with other waiver concepts, state proposals, or policy changes; 
• Waiver concepts that could advance some or all of the principles outlined in the 1332 Guidance released in 2018; 
• Waiver concepts that incorporate the entire range of waivable requirements allowed under section 1332; and
• How states might combine the flexibilities available under 1332 with other flexibilities that exist under

At the same time that the Trump administration announced that it has asked a federal court to repeal the entire Affordable Care Act, the Urban Institute has published a report detailing the potential impact of the health care reform law’s repeal.

According to the Urban Institute report, repealing the entire Affordable Care Act would add almost 20 million Americans to the ranks of the uninsured.  Medicaid and CHIP enrollment would fall by 15.4 million people and millions of others would lose the tax credits they used to purchase insurance.  Some would purchase insurance with limited benefits and individual plan premiums would rise while others would go uninsured.

In addition, repeal of the Affordable Care Act would lead to an 82 percent increase in hospital uncompensated care, to more than $50 billion.  About half of the states would see the amount of uncompensated care provided by their hospitals double, the Urban Institute estimates.

Learn more from the Healthcare Dive article “Killing ACA would lead to huge spikes in uncompensated care” and from the Urban Institute report State-by-State Estimates of the Coverage and Funding Consequences of Full Repeal of the ACA.

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Partial Medicaid expansion, desired by some Republican governors but rejected by the Trump administration last year, may not be so rejected after all.

At least not according to Seema Verma, administrator of the Centers for Medicare & Medicaid Services, which oversees the federal Medicaid program.

In a recent interview, Verma said the administration is reconsidering its rejection of partial Medicaid expansion, an idea she supports and that

What I have said to states and to governors [is] “Tell me what you want to do, and it’s my job to help you get to where you want to go.”

To emphasize this point, Verma also said that

We are changing the partnership between the federal and state government.  We are trying to empower states.

Learn more about Verma’s recent remarks about Medicaid expansion in the Politico article “Seema Verma:  Medicaid reform rejected by Trump is ‘under review.’”

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The Centers for Medicare & Medicaid Services has introduced four new “state relief and empowerment waivers” that are widely viewed as new vehicles for states to circumvent Affordable Care Act requirements to implement their own new approaches to health care.

• Through “account-based subsidies” waivers, states may direct public subsidies into defined-contribution, consumer-directed accounts that individuals use to pay for health insurance premiums or other health care expenses.
• “State-specific premium assistance” waivers enable states to create their own subsidy programs.
• “Adjusted plan options” authorizes states to provide financial assistance for different types of health insurance plans, including short-term and other health insurance policies that do not meet Affordable Care Act benefits and coverage requirements.
• “Risk stabilization strategies” waivers give states greater flexibility to implement reinsurance programs or high-risk pools.

These waiver options have been introduced not through regulations but through guidance published in the Federal Register.  States must apply for these waivers, which must meet section 1332 federal standards for  comprehensiveness, affordability, coverage, and federal deficit neutrality.

Learn more about state relief and empowerment waivers in this CMS fact sheet and this guidance that was published in the Federal Register.…

A recent study concluded that hospitals can expect to lose about $218 billion in federal Medicare and Medicaid payments between 2010, when the latest round of major cuts began, and 2028.

Among those cuts cited in the study, which was commissioned by the American Hospital Association and the Federation of American Hospitals, are:

• $79 billion for DRG documentation and coding adjustments
• $73 billion for Medicare sequestration
• $26 billion for Medicaid disproportionate share payments (Medicaid DSH)
• $11 billion in cuts associated with the American Taxpayer Relief Act of 2012

Other cuts came, or will be coming, through regulatory changes, the introduction of value-based payment programs, and other means.

Learn more about these cuts and their potential implications in this Healthcare Dive story.

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